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Raised ESR with normal FNAC, CT CHEST, ABDOMEN. TB?

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Hi Doctor. I am a 29 years old female. My ESR count is not coming down in last three months. It is rotating between 75 to 105. I have got my FNAC done which was tested negative. CT Scans of Chest, Abdomen and pelvis have also been done to detect TB but nothing has been found in that. I have not lost weight at all. But still my ESR count is extremely high. Only symptom is that I am having bronchitis in this weather and having sore throat on and off in this duration. Please Advice what should i do for it ?

Category: Pulmonologist

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Category: Allergy and Immunologist
 27 Doctors Online

Hello,
Thank you for your query at DoctorSpring.com
I do understand your anxiety and apprehension.
Are you married? Do you have any history of joint pain, still birth, abortion, etc?
I would not bother about a lab report, if you are normal. What bothers me is why you did it, which is not mentioned.
Can you please explain why ESR was checked? And from where fnac was taken?
Based on additional history if required you can get RA FACTOR and ANA FACTOR evaluated too.
I shall be glad to know more details to help you better.

Regards,
Dr. Jacob George
MD., IDCCM, FCCP


Patient replied :

Hello Doctor,
Thanks for the reply. I am not married. I got my ESR test done since I am taking treatment for depression from last 10 month. I have been taking one tablet of Paxy CR 25 daily. My psychitarist wanted to evaluate my overall health and side-effects of the medicine on my cholestoral levels. So he suggested a battery of tests which included heomoglobin [which was 10], ESR count, Cholestoral levels [which were fine], tests related to Thyroid [which were all normal] etc. Basically, all test reports were normal except for ESR count.
Then he reffered me to M.D. Internal Medicine who detected a very small lymph node near my Neck and got FNAC done [the reports of which were normal]. Since I am an Indian and Tuberclosis is normal here, he also got CT Scan done for Tuberclosis [Chest, Abdomen and Pelvis] which were also normal.
My ANA test was also done and it was negative.
I have a family history of Rheumatoid Arthritis as my mother is suffering from it for last 15 years and that of Bronchitis & Allergy [And I am suffering from it for last 20 years]. Plus, I am generally aneamic despite havind good diet.
I do not suffer from Diabities, Hypertension, do not smoke and drink occasionally [once in 3 months on an average].
I had a sinus infection and a surgery was done foe the same in 2011. But after that, I had no complains.
But right now, I am having minor cough these days related to my bronchitis. I am not taking any medicine for it.
I hope the above history will provide clarity.
Awaiting your response. Regards


Dear patient,

Regards from our side. It was an awesome reply to get.
More on the esr- it is a non-specific measure of inflammation. ESR is increased by any cause or focus of inflammation. ESR is increased in pregnancy, inflammation, anemia, and rheumatoid. However ESR is slightly on the higher side in females, although 75 is abnormal.
I would work up more on why you are anemic - as for me, anemia, and the reason for being anemic is causing high ESR..
So I will continue testing with a blood smear examination, do a serum iron,ferritin, bit b12, folate levels, still work up ana profile ( not ana alone). All being said and done, ana, ra, anti CCP etc can be positive only after some more time.
The other possibility of having a raised ESR is occult infection. And in your case, I suggest a sinus evaluation by an ent surgeon. Rhinitis asthma reflux,sinusitis and depression and OSA coexist and all needed to be treated simultaneously as a whole than on piece meal.
Though nothing to correlate work an elevated symptoms, I will really get you worked up for snoring send obstructive sleep apnea for the same reason just mentioned that they all coexist.
A small lymph node detected might have been normal on fnac. But it's mere presence might also suggest a small occult infection in the area where it acts as a sentinel guard. So if it's up in the neck, I will suspect a focus of dental caries or gum hygiene and treat for the same.
Nut shell- I will not lose my sleep bothering on a high esr., because THAT is not a disease but a disease manifestation. I will keep a high index of suspicion of early rheumatoid, keep testing it, along with work up for anemia and also rule out other focus of infection such as caries teeth,urinary tract infection, vaginal discharge, any fungal infection etc..
Hope it helps.

Regards,
Dr. JG


Dr. Jacob George Pulinilkunnathil
Category: Allergy and Immunologist
Experience: 
Residency, Post Graduation: MD, Respiratory Medicine, J L N Medical College, Ajmer, Rajasthan (2012).
Medical School, Internship: MBBS, Government Medical College, Kottayam, 2001-07 
Indian Diploma in Critical Care Medicine (IDCCM) - Medical Trust Hospital, 2013-2014.
Dr. Jacob George Pulinilkunnathil and 4 other Medical Specialists are ready to help you

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